6321 BROADWAY 2025-07-15 - Laserfiche WebLink

Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# gti3o2" 0 BUILDING BANNING Intake OK by: Date: Intake OK by: Assign To: Date: Intake Comments: Intake Comments: Zone Overlay/Agreement ❑ Route to Commercial Building Nonresidential Use ❑ Route to Residential Building Residential Use - ❑ Make this a"W" Permit Proposed No. of Dwelling Units: Bldg/TI/Addn/Rem Size Total No.of Dwelling Units: Garage/Accessory Struct. Size Planning/Landscape Inspection Required before Final? ❑Yes ❑No Number of Stories "In Lieu"Fee: Type: Amount$ Basement No ❑Yes , Fin/Unfin School Impact Fee: Total $ Type of Construction Calculated: Credit: Occupancy Group ❑Everett School Dist ❑Mukilteo School Dist Occupancy Load Park Impact Fees for permits applied for after 11112022: Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Park Impact Fee Total (net due after credit for existing uses) Reason Sprinklers Required: Fee Schedule Used For Calculation(Year): ------------ - ---------- ------------------------------------------ Fire Alarm: ❑Update Existing ❑New System ANot Req'd Permit Technician Use Only:Apply Phase-In Credit Per EMC19.53.200 - Reason Fire Alarm Required: ❑ 100%Credit-Issued 1/l/2022-9/2/2022 RCW 64.55 MF worksheet req'd for permit? ffl��(es No ❑ 50%Credit-Issued 9/3/2022-6/2/2023 Add'I RCW 64.55 docs required prior to final? ❑Yes 2No ❑ 0%Credit-Issued 6/3/2023 or later VALUATION CALCULATION: Total$IV4 0367,90 Additional Notes: A proved By: Date: PUBLIC WORKS Additional Notes: Intake OK by: Date: ------- ------------------- Intake Comments: ;PW Worksheet Needed if.- ❑Sys Dev Eval(Utiusvv)OTraffic Mit Eval Approved Dated ,7 Zh2 ❑Sete Work/Drainage ❑Address Letter ❑Backflow Prevention for high hazard: (dental,medlcal,animals,mortuary,hospital, FIRE DEPARTMENT ;supportive housing) Separate/Deferred Submittals Required: El Route this folder for PW Review at end ---PW Review Worksheet ❑Fire Sprinklers ❑Fire Alarm ❑Other: ❑This project also has a separate concurrent PW Review(Green Folder) Additional Notes: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑This Permit is Approved by Public Works Fire Dept. Fees: ❑ See PW Review Worksheet and associated attached items ❑ Review of As-Built Plans-NO FIRE FEE ❑A Separate PW Permit is Required(Permit#:PW- 12 Minimal or No Fire Scope-NO FIRE FEE AND ❑ Is located in this folder ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) Approved By:y ❑Will be issued separately(separate Green Folder,PW Issued ahead of Bldg) ❑ Public Works has no scope---PW Not Required ELECTRICALIPLUMBING Additional Notes: Additional Notes: Approved By: Date: lCompleted By: Date: